Undetectable HIV 101: Everything You Need To Know

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Being undetectable reduces the risk of HIV transmission to zero — even during unprotected sex.

Thanks to advancements in treatment options over the past three decades, HIV — the virus that causes AIDS — is no longer the death sentence that it was in the early 1980s. Although there is still no cure for HIV, life expectancy among those with HIV is, on average, only zero to five years shorter than the general population (zero to one year shorter for men; up to four years shorter for women). In fact, treatment today can be so successful that it can reduce the virus’ presence in the bloodstream to undetectable levels, effectively eliminating the risk of transmitting the virus. The Center for Disease Control (CDC) recently released a groundbreaking statement, acknowledging that “undetectable” HIV cannot be sexually transmitted, even during unprotected sex.

Although nearly half of all people with HIV in the U.S. are undetectable, the term is often misunderstood and those with HIV are still widely stigmatized. Here, we break down what it really means to be undetectable and how to get there.

What does it mean to be undetectable?

“Viral load” is the term used to describe the amount of HIV the blood of someone who is HIV-positive. The more HIV there is in your blood, the higher your viral load, the greater your risk of becoming ill because of HIV.

If you are HIV-positive and living with an undetectable viral load, it means that the amount of HIV in your blood is so low that the virus cannot be detected — which typically means there are less than 200 copies of the virus per milliliter of blood. If an HIV-positive person has an undetectable viral load, there is — again according to the CDC — “effectively no risk” of them transmitting HIV to an HIV-negative person, even during unprotected sex.

An undetectable viral load can be achieved by adhering to treatment, and can be maintained indefinitely. It does not, however, mean that the virus is cured, or that they will always be undetectable or, if an individual fails to keep up with their medications, couldn’t at some point transmit the virus.

How do you become undetectable?

Antiretroviral Therapy (ART) is a prescription medication that reduces the amount of HIV in the bloodstream, and has shown to be effective in slowing down the progression of AIDS and reducing HIV-related illness and death. If you are HIV-positive and take ART daily and as prescribed, it’s possible to achieve and maintain an undetectable viral load. If you test positive for HIV, talk to your doctor about treatment plans as soon as possible.

Is it hard to become undetectable?

According to the Prevention Access Campaign, nearly everyone who starts ART finds a drug regimen that works within six months. About one out of six people will need additional time to find the right treatment due to tolerance and adherence issues. Adherence to treatment and regular viral load monitoring are essential to maintaining an undetectable viral load.

Maintaining your undetectable status means taking charge of your health. It means seeing your doctor regularly, fully complying with your treatment program, and regularly getting tested to assess your viral levels. You may want to consider seeing a mental health professional to guide you through the stressors unique to living with HIV. It may not always be easy, but it is absolutely possible to live a long, healthy, and fulfilled life with undetectable HIV.

If my HIV is undetectable, do I need to disclose my status to my partner?

When it comes to sex, the CDC’s results from three different studies were unequivocal: undetectable HIV cannot be transmitted during intercourse, even during unprotected sex. However, it’s important to have honest conversations about sexual health with any partner before engaging in intimate behavior, and that means disclosing your HIV status and when your last test was — and you should expect the same of any new partner. Even if you’re confident that it won’t matter from either a medical or an interpersonal perspective, note that many states have HIV disclosure laws that require both parties to disclose regardless of HIV status. Make sure you know the laws in your state and protect yourself.

Being undetectable also doesn’t mean you should eschew other forms of protection, and you and your partner may want to discuss whether you want to use condoms or PrEP.

Eliminating The Stigma of Living With HIV

The better we’re able to understand undetectable status, the more comfortable it will be for HIV-positive people to be open with friends, partners, and healthcare providers.

“There is an expectation and responsibility often put on the HIV-positive person to disclose their status,” says Lighthouse therapist Jeremy Ortman, “but when the reception is so dehumanizing, it ultimately discourages open and honest communication on the subject.”

Although someone who is HIV-positive and undetectable has virtually the same chances of transmitting the virus as someone who is HIV-negative, eliminating the stigma around living with HIV will be an ongoing challenge. Those who have achieved an undetectable status should be celebrated for their commitment to self-care, and no one with HIV — undetectable or otherwise — should feel judged or shamed.

Interested in finding a doctor that specializes in HIV treatment or counseling? Find a Lighthouse provider near you.